The broad, long-term objective of this proposal is to improve the estimates of prognosis for patients with head and neck cancer. To achieve the broad long-term objective of this research program, the specific aim is to develop staging systems for cancers of the oral cavity, oropharynx, larynx, and hypopharynx which include descriptions of the patient as well as descriptions of the tumor. The widespread use of the TNM system during the past 30 years has unquestionably helped standardize morphologic classification of tumors, provide treatment guidelines, and improve estimates of prognosis. Despite these scientific contributions, however, non-morphologic factors, which often affect both prognosis and choice of treatment, remain unclassified and unanalyzed. The research design and methods include the identification of an inception cohort of patients with cancers of the oral cavity, oropharynx, larynx, and hypopharynx first treated at Washington University Medical Center. A retrospective review of the medical records will be performed and bivariate analysis will be conducted to identify the pre-treatment patient and tumor variables related to five-year survival for each of the four anatomic sites. Through a multivariable process, including conjunctive consolidation, prognostically relevant clinical variables will be added to the TNM-anatomic system for each of the sites. The newly formed composite clinical-severity systems will be quantitatively compared to the TNM- anatomic system. Despite the fact that many articles demonstrate the shortcomings of the TNM staging system, patients with cancer continue to be described by the morphology of the tumor, and little or no attention is given to the importance of the associated clinical manifestations. Because current anatomic staging systems identify form without function, the inclusion of clinical variables in a formal staging system can strikingly improve prognostic accuracy.